Basic Information
| Provider Information | |||||||||
| NPI: | 1700801875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROSS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD.,PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 278984 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146278984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853417420 | ||||||||
| FaxNumber: | 5857562311 | ||||||||
| Practice Location | |||||||||
| Address1: | 919 WESTFALL RD | ||||||||
| Address2: | BLDG C, STE 215 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853417420 | ||||||||
| FaxNumber: | 5857562311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 02/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084V0102X | 197683 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology |
ID Information
| ID | Type | State | Issuer | Description | 00040114001 | 01 | UNIVERA | OTHER | P010197683 | 01 | BLUE CHOICE | OTHER | 6325 | 01 | BLUE SHIELD | OTHER | MDA946 | 01 | PREFERRED CARE | OTHER | 01616339 | 05 | NY | MEDICAID | 5059134 | 01 | AETNA | OTHER |